Provider Demographics
NPI:1710284518
Name:KENNEBEC VALLEY DENTAL ARTS
Entity Type:Organization
Organization Name:KENNEBEC VALLEY DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-238-6235
Mailing Address - Street 1:51 WESTERN AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-1382
Mailing Address - Country:US
Mailing Address - Phone:207-238-6235
Mailing Address - Fax:207-238-6236
Practice Address - Street 1:51 WESTERN AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-1382
Practice Address - Country:US
Practice Address - Phone:207-238-6235
Practice Address - Fax:207-238-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental